HPV VACCINATION NOTIFICATION

The National HPV Vaccination Program Register (NHVPR) is fully funded by the Australian Government (Department of Health) and operated by VCS Ltd. Information is held securely and confidentially by the Register under specific legislation.

CONSUMER/PATIENT DETAILS

PRACTITIONER DETAILS

SCHOOL DETAILS

CONSENTER DETAILS

VACCINATION DETAILS

Surname:

First name: Middle name(s):

Previous surname (if applicable):

Date of birth:

Street address:Vaccine brand:

Postal address (if applicable):

Suburb:

Dose number: Batch number:Phone number:

State:

Postcode:

Suburb:

Consenter contact number:

State:

Postcode:

School name:

Consenter name (if applicable):

Relationship to consumer:

Consenter address (tick if same as consumer’s address):

School postcode: Year level:

Medicare provider number:

Provider name:

Signature: Date:

Practice name:

Phone number:

/ /

/ /

Vaccination date:/ /

Gender:

Medicare number:

Female Male Other, please specify below:

No

Torres Strait Islander

Aboriginal

Both Aboriginal and Torres Strait Islander

Gardasil 9 Gardasil 4 Cervarix

- -

Is the consumer of Aboriginal or Torres Strait Islander origin?

To return this form – FAX: (03) 8360 8699 or MAIL: Reply Paid 725, Sunshine VIC 3020For assistance or enquiries please call 1800 478 734 (1800 HPV REG) or visit www.hpvregister.org.au

Person numberon card:

For notification of a single administered dose.For notification of multiple doses, please see over for options.

NHVPR-F-3 v7 December 2017

HPV VACCINATION NOTIFICATION

The National HPV Vaccination Program Register (HPV Register)

supports the National HPV Vaccination Program by collecting information about HPV vaccine doses given across Australia.

While the program is now mainly delivered by schools, there may be circumstances where HPV vaccines are givenin general practice or other healthcare settings (eg. absence from school, personal preference).

Why notify?Notifying the HPV Register helps providers and patients to ensure HPV vaccine courses are completed. The HPV Register can help by:

• sending completion statements to those who have received all scheduled doses

• sending history statement reminders to those with an incomplete course within the schools program

• providing online overdue dose reports to providers, listing patients who have incomplete courses

• enabling providers to check the vaccination status of their patients (by phone or online)

If HPV doses are not notified to the HPV Register, this may increase the risk of too many doses being administered, or vaccination courses not being completed.

Participation in the HPV Register is also very important for monitoring how the HPV Vaccination Program is working and measuring the effect of the vaccine on HPV-related disease, including cervical cancer.

Who can notify?All medical practitioners and immunisation providers can notify HPV vaccine doses. Medical practitioners can set up access

to their online account for practice managers and nurses,

to facilitate submission of notifications within the practice.

Patients can opt-off at any time by contacting the HPV Register.

NHVPR-F-3 v7

December 2017

How can I notify?

Methods for notifying HPV vaccine dosesONLINE

DOCUMENT-BASED

HPV Register Secure Site

faxed or posted to the HPV Register

Single Dose • HPV Vaccination Notification form

Multiple Doses

• HPV Vaccination Notification form template (multiple doses)

• Reports generated from practice software

Requirements for notificationConsumer consent (written or verbal)

Minimum fields completed:

> Patient - Name, DOB, Gender, Address, Medicare Number

> Vaccination - Date, Dose Number, Vaccine Brand

> Practitioner - Provider Number

Note: Entering HPV vaccination details into practice software does not automatically result in notification to the HPV Register.

The online portal, forms and templates are all accessible at hpvregister.org.au/health-professionals

Where can I get more information?National HPV Vaccination Program Registerwww.hpvregister.org.au Tel: 1800 478 734Fax: 03 8360 8699Posted notifications: Reply Paid 725, Sunshine VIC 3020

Immunise Australiawww.immunise.health.gov.auTel: 1800 671 811

Cancer Council Australiawww.hpvvaccine.org.auTel: 13 11 20

Has your practice notified HPV vaccinations to the Register?

Where HPV vaccine doses are notified to the Australian Immunisation Register (AIR), these will be periodically forwarded to the HPV Register. Please note there will be a delay in receipt of notifications when these are provided to AIR rather than the HPV Register directly.